Infrainguinal open reconstruction: a review of surgical considerations and expected outcomes
Identifieur interne : 000476 ( Main/Exploration ); précédent : 000475; suivant : 000477Infrainguinal open reconstruction: a review of surgical considerations and expected outcomes
Auteurs : Sevan R. Komshian [États-Unis] ; Kimberly Lu [États-Unis] ; Steven L. Pike [États-Unis] ; Jeffrey J. Siracuse [États-Unis]Source :
- Vascular Health and Risk Management [ 1176-6344 ] ; 2017.
Abstract
Infrainguinal arterial occlusive disease can lead to potentially disabling and limb-threatening conditions. Revascularization may be indicated for claudication, rest pain, or tissue loss. Although endovascular interventions are becoming more prevalent, open surgeries such as endarterectomy and bypass are still needed and performed regularly. Open reconstruction has been associated with postoperative morbidity, both at the local and at the systemic levels. Local complications include surgical site infections (SSIs 0–5.3%), graft failure (12–60%), and amputation (5.7–27%), and more systemic issues include cardiac (2.6–18.4%), respiratory (2.5%), renal (4%), neurovascular (1.5%), and thromboembolic (0.2–1%) complications. While such outcomes present an additional challenge to the postoperative management of surgical patients, it may be possible to minimize their occurrence through careful risk stratification and preoperative assessment. Therefore, individualized selection of candidates for open repair requires weighing the need for intervention against the likelihood of adverse outcomes based on preoperative risk factors. This review provides an overview of open reconstruction, focusing on identifying the clinical indications for surgery and perioperative morbidity and mortality.
Url:
DOI: 10.2147/VHRM.S106898
PubMed: 28507439
PubMed Central: 5428788
Affiliations:
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Komshian</name><affiliation wicri:level="1"><nlm:aff id="af1-vhrm-13-161">Division of Vascular and Endovascular Surgery, School of Medicine, Boston University Boston, MA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Vascular and Endovascular Surgery, School of Medicine, Boston University Boston, MA</wicri:regionArea><wicri:noRegion>MA</wicri:noRegion></affiliation></author><author><name sortKey="Lu, Kimberly" sort="Lu, Kimberly" uniqKey="Lu K" first="Kimberly" last="Lu">Kimberly Lu</name><affiliation wicri:level="1"><nlm:aff id="af1-vhrm-13-161">Division of Vascular and Endovascular Surgery, School of Medicine, Boston University Boston, MA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Vascular and Endovascular Surgery, School of Medicine, Boston University Boston, MA</wicri:regionArea><wicri:noRegion>MA</wicri:noRegion></affiliation></author><author><name sortKey="Pike, Steven L" sort="Pike, Steven L" uniqKey="Pike S" first="Steven L" last="Pike">Steven L. Pike</name><affiliation wicri:level="1"><nlm:aff id="af1-vhrm-13-161">Division of Vascular and Endovascular Surgery, School of Medicine, Boston University Boston, MA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Vascular and Endovascular Surgery, School of Medicine, Boston University Boston, MA</wicri:regionArea><wicri:noRegion>MA</wicri:noRegion></affiliation></author><author><name sortKey="Siracuse, Jeffrey J" sort="Siracuse, Jeffrey J" uniqKey="Siracuse J" first="Jeffrey J" last="Siracuse">Jeffrey J. Siracuse</name><affiliation wicri:level="1"><nlm:aff id="af1-vhrm-13-161">Division of Vascular and Endovascular Surgery, School of Medicine, Boston University Boston, MA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Vascular and Endovascular Surgery, School of Medicine, Boston University Boston, MA</wicri:regionArea><wicri:noRegion>MA</wicri:noRegion></affiliation></author></analytic><series><title level="j">Vascular Health and Risk Management</title><idno type="ISSN">1176-6344</idno><idno type="eISSN">1178-2048</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Infrainguinal arterial occlusive disease can lead to potentially disabling and limb-threatening conditions. Revascularization may be indicated for claudication, rest pain, or tissue loss. Although endovascular interventions are becoming more prevalent, open surgeries such as endarterectomy and bypass are still needed and performed regularly. Open reconstruction has been associated with postoperative morbidity, both at the local and at the systemic levels. Local complications include surgical site infections (SSIs 0–5.3%), graft failure (12–60%), and amputation (5.7–27%), and more systemic issues include cardiac (2.6–18.4%), respiratory (2.5%), renal (4%), neurovascular (1.5%), and thromboembolic (0.2–1%) complications. While such outcomes present an additional challenge to the postoperative management of surgical patients, it may be possible to minimize their occurrence through careful risk stratification and preoperative assessment. Therefore, individualized selection of candidates for open repair requires weighing the need for intervention against the likelihood of adverse outcomes based on preoperative risk factors. This review provides an overview of open reconstruction, focusing on identifying the clinical indications for surgery and perioperative morbidity and mortality.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Norgren, L" uniqKey="Norgren L">L Norgren</name></author><author><name sortKey="Hiatt, Wr" uniqKey="Hiatt W">WR Hiatt</name></author><author><name sortKey="Dormandy, Ja" uniqKey="Dormandy J">JA Dormandy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hirsch, At" uniqKey="Hirsch A">AT Hirsch</name></author><author><name sortKey="Hartman, L" uniqKey="Hartman L">L Hartman</name></author><author><name sortKey="Town, Rj" uniqKey="Town R">RJ Town</name></author><author><name sortKey="Virnig, Ba" uniqKey="Virnig B">BA Virnig</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Conte, Ms" uniqKey="Conte M">MS Conte</name></author><author><name sortKey="Pomposelli, Fb" 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Gill</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Siracuse, Jj" uniqKey="Siracuse J">JJ Siracuse</name></author><author><name sortKey="Menard, Mt" uniqKey="Menard M">MT Menard</name></author><author><name sortKey="Eslami, Mh" uniqKey="Eslami M">MH Eslami</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Geraghty, Aj" uniqKey="Geraghty A">AJ Geraghty</name></author><author><name sortKey="Welch, K" uniqKey="Welch K">K Welch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alabi, O" uniqKey="Alabi O">O Alabi</name></author><author><name sortKey="Roos, M" uniqKey="Roos M">M Roos</name></author><author><name sortKey="Landry, G" uniqKey="Landry G">G Landry</name></author><author><name sortKey="Moneta, G" uniqKey="Moneta G">G Moneta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rollins, Ke" uniqKey="Rollins K">KE Rollins</name></author><author><name sortKey="Coughlin, Pa" uniqKey="Coughlin P">PA Coughlin</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>États-Unis</li></country></list><tree><country name="États-Unis"><noRegion><name sortKey="Komshian, Sevan R" sort="Komshian, Sevan R" uniqKey="Komshian S" first="Sevan R" last="Komshian">Sevan R. Komshian</name></noRegion><name sortKey="Lu, Kimberly" sort="Lu, Kimberly" uniqKey="Lu K" first="Kimberly" last="Lu">Kimberly Lu</name><name sortKey="Pike, Steven L" sort="Pike, Steven L" uniqKey="Pike S" first="Steven L" last="Pike">Steven L. Pike</name><name sortKey="Siracuse, Jeffrey J" sort="Siracuse, Jeffrey J" uniqKey="Siracuse J" first="Jeffrey J" last="Siracuse">Jeffrey J. Siracuse</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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